Endodontics
Course Review
Enoch Ng, DDS 2014
Non-microbial Causes
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Cysts – pathologic epithelium lined pocket filled with fluid and necrotic debris
bay cyst (pocket cyst) – cyst is connected to and opens into apex of canal
true cyst
residual cyst
o
Controversial whether will heal after NSRCT
o
Incidence – 5-55%, more current literature indicates 15-17% prevalence
o
Radiographs NOT diagnostic for cystic vs noncystic lesions
o
Suspect cyst if lesion > 200mm
2
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Foreign Body Reaction
o
Extruded GP – delayed healing of apical tissues
o
Paper points
o
Amalgam
o
Sealer
o
Extruded Ca(OH)
2
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Scars – very uncommon
o
Occasionally (2-6%) unresolved apical radiolucency may be a scar
o
Can only be determined histologically
Summary
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Endo therapy = healing 82-94%
o
Dependent on pre-treatment and treatment factors
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Persistant PA lesions caused by
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Persisting intraradicular infection
o
Extraradicular infection, plaques, biofilms
o
Extruded RCT filling/other materials
o
Cysts
o
Scars
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Treat microbes
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Consider POORPAST for residual symptoms
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Appreciate RCT complexity – know when to refer
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Control your materials
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Restore, follow up, keep patient informed
